Mixed advice about breastfeeding and making up formula from midwives

[iwouldgoouttonight]

I'm getting quite annoyed about how my midwifes/HVs are giving inconsistent information. I breastfed DD for 5 days before she was admitted to hospital having lost 17% of the birth weight and was severely dehydrated. In those first five days I saw three different midwives who all said she was latched on well and congratulated me on how well I was getting on with BF. I was concerned as DD hadn't done any wet nappies but they reassured me that it was fine. On the fifth day I saw a different midwife again who watched me feeding, saw that DD wasn't latched on properly at all, was hardly taking any milk and not having wet nappies was a sign of concern. She then weighed her which was when we were sent straight to hospital.

Anyway, long story but we have now ended up formula feeding which I have come to terms with. The midwife I saw when I came out of hospital made it very clear that the rules regarding making up formula have changed and that I must make a fresh bottle each time and boil fresh water and let it cool slightly before adding powder, and to never make up bottles of water in advance and add powder throughout the day when needed. Fine, so I am making up fresh bottles each time, no problem.

But today I was at a friend's house who is FF and her midwife told her while I was there that its fine to boil water, put it in the bottles and then leave it all day before adding powder. I actually challenged her saying this wasn't the advice any more and she said it is. So now my friend is left worrying about what to do because the information is unclear.

I'm not worried too much about making up formula as I'm happy to make a fresh bottle each time and confident that is the correct way to do it. But it just makes me so annoyed that some midwives don't appear to know what they're doing!

I'm not sure why I'm posting this really but just wanted to get it off my chest. I'm sure many babies could avoid becoming ill, and mother's avoid becoming stressed and worried, if only midwives were better trained. Hopefully it is just our team who are particularly bad and it is better elsewhere.

Does anyone else think we need to start putting pressure on the m ilk companies to make cartons the same price, weight for weight, as powder.

Why should babies on a budget be more likely to get gastroenteritis than those who are not? Do milk tokens cover ready mixed milk?

And with the guidelines as unmanagebale as they are [unless you never leave the house, or bring a kettle, and can magically predict 30 mins from baby's feeding time] it seems that this is what it amounts to.

Set of hooligans.

Climbs off soapbox and blushes

So if it is about the water being hot enough to kill the bugs then assuming they are dead why is it a problem making up bottles a few hours in advance? If there are no bacteria then none can multiply.

Personally I would be happier doing that than relying on the 'sterile' practice in the factory that makes the cartons Someone please explain why I am wrong.

Egg-zactly, Brettgirl and treedelivery!!!

If you make the bottles in advance with water hot enough to kill bugs in the first place, then why/when do they multiply?

I still don't see why you can't make up a feed with half cooled boiled water (stored in sterile bottle) and half boiled water. Just add the powder to the boiled water half then mix with the cooled. Faster, and surely the bacteria has been killed off?

Treedelivery, the making of bottles from powder has become so fiddly even at home due to all the reasons you have identified, that it becomes easier and easier (and costs more and more )to just use cartons when faced with a screaming hungry baby...

Thanks for all your comments - it seems many people are slightly confused about the whole formula thing - this thread is very similar to the conversation me and my friend and her husband had when her MW had left. Too much conflicting advice from health care professionals.

I agree ready made formula should be the same price as powder - I make up bottles fresh each time now and have had many near scalding, screaming baby, losing count of how many scoops I've just put in incidents! Makes me even more cross about the fact that the whole faff and worry could have been avoided if MWs had helped me with BFing.

I have sent a letter of complaint about the service me and DD received from our midwives when BF - not sure what it will do but if it means they get better training and it stops it happening again to another family it will have helped.

Well done for sending that letter.
DS was re-admitted to hospital at 6 days old having lost 20% of his birthweight, he was my first dc and I didn't know he wasn't latching on properly.
He had to be tube-fed overnight and given FF until one MW said 'this baby is going to feed' and stayed with me until he did.
You must be feeling anxious about feeding and conflicting advice is not what you need.
Sorry I can't help, I know nothing about FF but just wanted to wish you luck!

Iwouldgoouttonight (Like your name BTW!), I found it very useful to have a container with premeasured amounts of formula ( I had the Avent one, which fitted up to 7 scoops), because I was always losing count, and it seemed easier to measure it in when I had a quiet 5 mins, and then keep it on the side.

Also, another way to make up formula (which I got from mumsnet), was to have the cooled boiled water in the fridge, microwave it to 70 degrees (1 min in my microwave - i tested it wth a food thermometer) add formula, shake and run it under the cold tap for a couple of minutes.

Hope I haven't added to your confusion!

Hi iwouldgoouttonight
The information your friend's midwife told her is the alternative method that the aptamil helpline also suggest. They say that if you are literally adding the powder just before you feed ( to a bottle of previously boiled water that has been left on the worktop for no longer than 24hrs)then there is no time for the bacteria to grow. So basically, as long as the water has been previously boiled, its fine to add the scoops at feed time. Its so confusing!

Good for you sending a letter of complaint it sounds like you had a rubbish experience. I am particularly impressed that you were able to do while dealing with a newborn and the aftermath of a horrible experience with her weight loss.

"Gingerbics, my father in law who is a GP said it was fine to boil water in the morning, leave it in a lidded container and use as requred so that it is adequately cooled."

No suprise there then: gps don't often seem to know much about infant feeding - breast or bottle. Shocking really given how much they're paid.

Oh boy,
My dd has been on bottles of aptimil for past 2 months, (now 6 months) and I have to admit that I boil the kettle in the morning for the days bottle. I add the formula when needed and (I may regret saying this) reheat in the microwave!!!! I always shake well and check temperature very carefully. Every mum I have spoken to at my many baby groups does the same thing! Im aware of the recommendations but it is just not practical to boil the kettle each time and also have a life. My dd gets out and about to baby groups / family friends every day and we often have to take a bottle or 2 and food with us. I dont know how we could go out to a baby group or for a shopping trip if I didnt take a bottle of pre-boiled water with us? Do people go to places with kettles?

"The formula companies issue this advice themselves in the form of instructions on the tin, basically the safest way is that on the tin and other ways are less safe."

i don't think they all do, sorry.

AFAIK, at least one well known brand of formula still doesn't follow the guidelines. Because it makes the powder go lumpy. i am amazed they are allowed to flaunt the guidelines.

nicnic01

You have to do what you can do, and the bottom line is that it's your choice.

I just have a problem with the fact that so few people seem to understand why the regulations were changed or what the risks are of making up bottles with cool water/keeping made up formula. It really annoys me that mums are constantly being given assurances that it's 'fine' by other people - often health professionals - who actually don't understand what the issues are in the first place.

Don't you think that we're all getting a bit to carried away with what the "regulations" tell us to do?? I don't know of any babies who've become sick because of when their mum's boiled the water for their milk???? Risk management gone mad if you ask me

standanddeliver- I think its one thing to have a go about midwives or health visitors who aren't aware of latest guidance and the rationale on FF etc but its not a GP's role to do that.

lal123 babies have died from this. it is very rare, but really not worth the risk.

the water needs to be hot enough to kill the bacteria in the milk powder.

previously boiled cool water is no good unless it is 70deg when it meets the formula.

Lal, just because you personally don't know any babies who have become seriously ill because of the way their formula was made up, doesn't mean it doesn't exist.

many many times, babies are hospitalised for illness and no one does any forensic investigations to verify the cause of illness. it will only happen if the baby dies.

happily, you and most of us have not had a baby we know die because of poor formula preparation.

it is common for posters on hereto say 'regulations', 'recommendations', and 'guidelines' because that is what they are. they are also trying to give unbiased, information as opposed anecdote, hearsay and momory.

sorry for typos and poor grammar. grumpy baby nearby

Foxytocin, do you believe that when babies are hospitalised it is often due to poor formula preparation?

I agree that we should be very careful when preparing feeds, but I have never heard (in rl or in the news) of a baby dying because of how their formula has been made up.

If I'm wrong, then apologies!

it do not matter what I 'believe', rosie. there is enough information out there that suggest that that is the case.

a ff baby is at a significantly increased risk of suffering from d&v and be hospitalised while still being excl ff.

i am sure no one is suggesting that just because a baby is poorly enough to be hospitalised doesn't mean that we shouldn't be concerned about their poor health. anytime a baby is ill it is stressful and upsetting for the parent and child. surely if this one step can prevent some illnesses in ff baby, then it ought to be followed as closely as you are able to do so?

that approx 10% of all tins of formula is contaminated with entrobacter and salmonella - and this is about tins of formula manufactured in the UK/Europe, not China or some other overseas nation.

pressed post too soon.

...makes it more likely that ff babies are likely to become ill from not following current feeding guidelines.

btw, enterobacter is linked to meningitis in babies and meningitis is more common in ff babies. it may not always be a direct causal link in many cases of meningitis, however, the possibility is there.

I don't want to scare ff mothers at all so i am sorry if what i am writing may read like I am. it is about lowering the risks as much as we can with the information available to us.

Agree with everything Foxytocin says.

We can't be certain what proportion of the ff infants made ill by diarrhoea and other infections are affected by poor formula preparation - as far as I know there are no figures on this. It's of course plausible that ff infants, who do not have the antibody protection of breastmilk, are more likely to succumb to infection if feeding equipment and preparation is not clean.

However, the (very small) no. of infants who acually died from enterobacter sakerzakii were found to have contracted the bacteria from infected formula powder, and these cases are what led to the new guidance.

What has confused parents, and HCPs, is that the guidance is new because of this knowledge about the powder, and it has nothing to do with the cleanliness or otherwise of the equipment. Traditionally, clean preparation guidance has been put in place because we have been aware, over a few generations, of the infection-causing properties of milk, especially warmed milk, but the new guidance is for different reasons.

Nothing you can do can 'make' powdered milk germ-free, if it is not germ-free at the point of preparation. All you can do is prevent the bacteria from being activated and multiplying.

The stats show the risk is small, but seems to me only right that people should know about it, and understand why the guidance got more complicated. It's clearly stated in all the leaflets, and in training materials for HCPs, but this is not what guides everyone's behaviour.

I recently had to start DS on formula and went up to the 'milk kitchen' at the local Children's Hospital to learn how to make it. (they should call it formula kitchen...)

Anyway, there is boiled water on the tap, and it's measured and cooled down for 20 minutes, and then made up into a batch, stored in BPA free bottles. Enough is made for 24 hours.

Didn't get into sterilizing equipment as DS is over 12 months and was told that it wasn't necessary.

Best to read the guidance directly here

Tik-tok, what is the temperature range for bacteria being re-activated? Are people who use cooled boiled water at risk of re-activating bacteria?

My method was always to heat refrigerated boiled water in the microwave, add powder then cool down to right temp for baby.

My friend has a 7 week old and her midwife said it was fine to just use cooled previously boiled water which has been stored in bottles on the worktop (no reheating or anything). Doesn't seem right to me.